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1 Confronting Teen Stress: Meeting the Challenge in Baltimore City A Guide for Parents, Teachers, & Youth Service Providers

2 Who Doesn t Know About Stress? As adults, you deal with stress in many aspects of your lives meeting work responsibilities, paying bills, caring for kids, or navigating relationships. When you raise your children or work with other teens, you are exposed to their stress and helping them can be challenging. The purpose of this guide is to provide information to adults who are invested in the lives of youth about teen stress and healthy ways to help teens cope with their stress. This guide is intended for adults who work with youth in middle school and in high school. On the next few pages, you will find general information about teen stress and results from a Baltimore City study called Shifting the Lens. The remainder of the guide is a toolkit with strategies and activities for working with youth one-to-one, in small groups, and in large groups. Activity handouts are located together, in the back of the guide. Stress is not all bad. Stress helps you to deal with life s challenges, to give your best performance, and to meet a tough situation with focus. The body s stress response is important and necessary. However, when too much stress builds up, you may encounter many physical and emotional health problems. If you don t deal with stress, the health problems can stay with you and worsen over the course of your life. Page 2 Confronting Teen Stress

3 Teen stress is an important, yet often overlooked, health issue. We know that the early teen years are marked by rapid changes. Most teens face stress from puberty, changing relationships with peers, new demands of school, safety issues in their neighborhoods, and responsibilities to their families. The way in which teens cope with this stress can have significant short- and long-term consequences on their physical and emotional health. Difficulties in handling stress can lead to mental health problems, such as depression. In Baltimore City, adults are all too aware of the stresses of living in a city traffic jams, fear of crime, abandoned homes, etc. However, the voices of teens often are missing. Do teens think these issues are the major sources of stress in their lives? The Shifting the Lens study set out to learn about Baltimore City teens views. The next couple of pages report on what was learned in the study. I think stress is a problem for teenagers like me...because when you get a certain age you start worrying about certain things, like when your puberty comes your body starts to develop more and then you get to worry about school, your families, and what most people think about you. a 14-year-old Baltimore City teen Meeting the Challenge in Baltimore City Page 3

4 Shifting the Lens A focus on stress and coping among East Baltimore African American adolescents Very little research focuses on how urban, African American teens view stress. Shifting the Lens was developed to add the youth perspective on how teens perceive and handle stress in their lives. The purpose of this project was to involve youth as the leaders in starting a dialogue on the topic of stress within their community. About the Study We collected data from teens (ages years), primary caregivers, and youth service providers on the topic of teen stress. Teens completed questionnaires, month-long tape-recorded journals of their daily stress experiences, activities in which they sorted stress by frequency and level of worry, and diagrams of where they turn for support. Primary caregivers participated in focus groups and completed questionnaires. Youth service providers also were interviewed. What Teens Said From a list of 16 stressors identified by teens: The five most frequently experienced sources of stress in the lives of participating youth are: school work (78%), parents (68%), romantic relationships (64%), friends problems (64%), and younger siblings (64%). The five sources of stress that cause the most worry in the lives of participating youth are: school work (68%), parents (56%), friends problems (52%), romantic relationships (48%), and drugs in the neighborhood (48%). On average, boys report more frequent use of avoidance and distraction coping strategies than girls, while girls indicate more frequent use of support seeking and active coping. Avoidance strategies involve not dealing with the stress at all. Distraction involves temporarily getting one s mind off the stress. Support seeking includes getting help. Active coping entails taking action to reduce or remove the stress. Page 4 Confronting Teen Stress

5 What the Study Tells Us 1. Girls report experiencing stress more than boys. Girls attribute most of their stress to their relationships with boys and their friendships with other girls, while boys mention difficulties with authority, such as teachers. Recommendation: Stress management programs should include special activities for girls only and special activities for boys only. 2. Family members and friends are both sources of stress and social support in teens lives. Recommendation: Youth development programs should include discussions around relationship stress and should teach ways to begin conversations about stress with families and friends. 3. Teens use healthy and unhealthy coping strategies. Unhealthy coping strategies include aggression and getting into fights. Avoidance strategies also are unhealthy. Recommendation: Programs should emphasize positive strategies such as seeking outside advice while continuing to teach the unhealthy consequences of using only avoidance strategies. For instance, providing teens with healthy ways of coping (e.g., journaling) can make avoidance behavior more positive. It s okay for somebody to get stressed, as long as they get it out though. That s the only thing. You gotta get it out. You can t keep it all in. -Teen in study When you a teenager that s the time every move, you know everything you do...it s like...they [parents] don t trust you or they being too hard on you, or they just want to be in your business -Teen in study Phase Two: Video Production The Shifting the Lens Teen Video Production Team completed Focus on Teens, a 13-minute video that informs parents and other adults about the issue of teen stress. To date, the teens have presented the video and led discussions with over 100 community members. The Shifting the Lens study provides many interesting findings and quotes from teens and adults. If you are interested in more information about the study and its results or if you would like to obtain a copy of the teens video, call the Center for Adolescent Health at or visit our website: Now Available! Meeting the Challenge in Baltimore City Page 5

6 Teen Stress Toolkit The rest of this guide serves as a toolkit for helping teens address stress in their lives. This toolkit for parents, teachers, and youth service providers is divided into sections for working with teens in a variety of settings: one-to-one, in small groups, and in large groups. In the back, you will find handouts for some of the activities and a list of resources. Also, look for comments by teens, like the one by Gretchen below. Tools of the Trade There are several tools to help teens with their stress. One way is to help them patch the holes, or address stressful situations immediately. You can encourage them to: listen to music, play sports, go out with friends, stay in their rooms, get angry, or cry. The pamphlet on pages 17 and 18, Stress: A Silent Killer talks about signs of teen stress, how teens can cope with stress, and places where teens can call for help. Adults, you should read and copy it so you can give it to teens. The pamphlet was made by teens and gives teens something to look at for information on stress. For teens to deal with the underlying stress, you also can help them repair the damage by understanding the stress and identifying and practicing positive ways to manage the stress. This guide contains several activities: a stress checklist, relaxation breathing, role-playing, and skits. Ultimately, you should seek more long-term change by rebuilding, or creating new patterns of behavior among individuals and institutions. For example, you might help a teen develop new ways of responding to family stress, or you and a group of teens may advocate for changes in the school, which will reduce the source of stress. This level of action usually requires more intense involvement than this guide offers. Page 6 Confronting Teen Stress

7 Remember what life is like for teens listen, be open, and realize that you might not always be able to relate to what they re feeling and that s okay. The key to helping teens is to stay ALERT to their stress: A cknowledge that teen stress is often different from adult stress. L E isten to teens and be aware of how teens respond to your level of involvement. Sometimes, just listening is enough. ncourage teens to express how they re feeling when they are stressed. R T ecognize that teens may have different experiences from each other. Assume that you will have at least one person in your group who will have a different experience. une in to your own levels of stress. Learn to say No. Try to sort out what is most important in your life. Listen to the wisdom of your body. Eat healthy, get exercise, and make sure you get enough sleep. Keep your sense of humor. Laughter can do wonders for your stress. How you deal with your own stress is linked to how you help teens, how they experience stress, and how they learn to cope with their stress. Meeting the Challenge in Baltimore City Page 7

8 One-to-One If you re a parent or other adult who interacts with individual teens, this section will provide you with some useful tools, like a stress checklist, active listening skills, and conversation starters. One place to start talking about stress is to use a stress checklist, such as the one included on Handout #1 on page 14. The checklist is only a guide to explore teen stress and should not be used as a diagnostic tool. Use this checklist to ask a teen about what he or she is experiencing, or review it together. Use the suggestions below to help you address stress. In question #1 of the checklist, a teen indicates the potential sources of stress in his or her life. Help the teen to recognize that this event may bring stress. Advise teen to talk about the problem with you or someone else they trust. Use some of the active listening skills on the right-hand page. In question #2, a teen indicates that he or she is feeling possible stress-related symptoms. Discuss how stress creates physical and emotional problems. Provide teen with ways to cope and feel better, such as taking deep breaths, playing sports, writing in a journal, or talking it out with you or a peer. Work with the teen to find out where the stress is coming from and to find ways to cope in the future. In question #3, a teen says that he or she is having an increase in bad feelings and stress. Helping a teen to face these issues requires a long-term solution. Refer a teen to a counselor or other licensed professional for therapy. A helpful resource to start with is the Maryland Youth Crisis Hotline: How do I deal with a crisis? Sometimes a teen may be so upset that he or she is thinking about suicide or hurting others. In this situation, respond right away. Stay with the teen and contact an individual or organization that can deal with the teen s crisis. These local resources are able to assist: Baltimore Children and Adolescent Response System (BCARS) United Way s First Call for Help or Page 8 Confronting Teen Stress

9 Active Listening* Even with active listening, the teen should talk more than you do. Next time you have a conversation, try these steps: Encourage. Sound open and positive. Fact Find. Gather information (Who, What, Why, When, Where, & How). Restate. Repeat what the teen is saying in another way so you can be clear about what he or she means. Reflect. Identify his or her feelings based on what you have heard. Summarize. Clearly state any conclusions or decisions decided upon by both of you. Conversation Starters Always make sure you have time to listen and talk before you start. If you want to encourage a teen to talk, avoid questions with yes, no, or just one word. Start with Tell me about or What do you think about You might start a conversation by mentioning a television show: What do you think about the boys in that ad? Do you know anyone who is like that? Show your interest in his or her life: I hear prom is coming up. What do you think about it? Additional Resources for Working One-to-One *Advocates for Youth has suggestions like the ones above for listening and talking with teens. Go to their parent section at: Campaign for Our Children also provides conversation starters and other ideas. Go to the parent resources section at: If a teen has something on their mind, listen. Make sure that they understand that they can talk about it. Why should they hold it in? Meeting the Challenge in Baltimore City Page 9

10 Small Group This section contains activities to explore stress in-depth with one or more small groups of teens. In both Mind-Body Connection (below) and in Trading Faces (next page), teens use their senses to process their stress. Mind-Body Connection Objective: Teens will identify physical and emotional feelings related to stress. Materials: Handout #2 (pg. 15) for each teen & markers Approximate Time: 30 minutes Relaxation Breathing Teach teens relaxation breathing with this 3 minute exercise. Encourage them to sit comfortably in their own space. Motivation: Have the teens make a fist really hard for 30-seconds and then say, Let go. Ask them how it felt when they made their fist and when they relaxed it. Explain that today s activity will focus on how our body acts under stress. Procedure 1. Distribute the body handout to each teen. 2. Encourage teens to think of a time when each of them felt stressed out in the past two weeks. Tell them to think back to how the stress made them feel. 3. Invite teens to draw on their individual body handout where stress was and how it made them feel. They may draw any pictures or symbols and may use any colors they choose. 4. After 5 minutes, go around and have each teen share. Ask them to talk about the stress, how it felt, and why they used the symbols and colors on their handout. 5. Continue the discussion by asking teens how they coped with the stress and if they did anything to make the emotional and physical feelings go away. 6. If you have time, explain that one way to deal with stressful situations is relaxation breathing. Go over the way to do it with the box to the right. Closure: Remind the teens to pay attention to how their bodies feel when they experience stress and suggest that they can use relaxation breathing for self-calming. SAY: Closing your eyes and beginning to breathe easily and evenly, in and out. It may help to think silently to yourself to get in tune with your breathing. One example is, Breathing in, I am calming...breathing out, I am coping. Continuing to breathe in and out in silence. If you are getting distracted, that s okay. Return to your breath. AFTER 2 MINUTES, SAY: Taking time just notice and enjoy that you feel more calm and relaxed. AFTER ANOTHER MINUTE, SAY: Now, to finish your relaxation breathing, take a final deep breath, open your eyes, stand up and stretch. Page 10 Confronting Teen Stress

11 Objective: Teens will learn the difference between reacting and responding to a conflict. Materials: none Trading Faces Approximate Time: 45 minutes Procedure 1. Explain that teens will work in pairs to role play about conflicts between two people. 2. Explain that each pair of teens will think about the relationship between the people, come up with a conflict that is common, and practice acting out the conflict and solving it. 3. Invite teens to get into pairs and to find a space to work in. 4. Pick one of the following relationships for each pair of teens: a. Parent and teenage child b. Teacher and student c. Two friends 5. After five to ten minutes, stop and get the attention of the pairs. Explain that in a minute, you will go around and have each pair act out their conflict for everyone else. Invite the teens to look for whether the people are REACTING or RESPONDING to the conflict. REACTING involves being aggressive, like losing your temper or intimidating someone. It also could involve manipulation. RESPONDING involves taking time to assess the situation, listening to the feelings of the other person, and then choosing an action that is best for all concerned. 6. Have each pair act out their conflict and the response to the conflict. In order to keep things moving, tell the teens that they only have 2 minutes. Invite the entire group to comment on whether the person is reacting or responding and why. 7. After all pairs have presented, tell the pairs that they will have five minutes to go back and practice the role play again, this time with the person responding rather than reacting. If they already responded, the pair can choose an entirely new relationship and conflict to practice. Closure Ask the teens what they thought about the activity. Did they feel that they were more successful when they responded instead of reacted? Ask them which one produced less stress. Remind teens to respond rather than react when they are in a conflict. Additional Resources for Working in Small Groups The Holistic Life Foundation provides yoga classes for Baltimore City youth. Call for more information. Talk With Teens About Feelings, Family, Relationships, and the Future: 50 Guided Discussions for School and Counseling Groups, by Jean Sunde Peterson. $17. Look for it on-line or in your bookstore. Teach kids to change the music in their heads...kids can consciously change the tape, teaching themselves to say, I can do it This is going to be okay, if only I breathe through it. Dr. Ann Engelland Meeting the Challenge in Baltimore City Page 11

12 Large Group This section offers activities to explore stress with a large group of teens. In the Coping with It activity below, teens have an opportunity to identify and to practice healthy coping. Coping With It Objective: Teens will identify unhealthy and healthy ways to cope with a stressful situation. Materials: Handout #3 (pg. 16) for each group of 4 or 5 Approximate Time: 1 1 1/2 hours (May be split up over two sessions) Motivation: Ask the teens to describe the difference between healthy and unhealthy foods. How do they know what is healthy? Explain that the ways we cope with stress in our lives also can be healthy or unhealthy (see box). Ask for examples. Tell them that today they will participate in a skit activity to understand healthy and unhealthy ways to cope with stress. Procedure 1. Tell the teens that they will be assigned to a team and a situation to act out in front of the large group. Their team should plan a short skit with a role for each person using the assigned situation. Their skit should include an unhealthy coping strategy. 2. Tell them that they will present the skit to the large group. After they present, the large group will comment on the unhealthy coping strategy. The team will then choose one volunteer from the large group to take the place of the stressed teen and act out a healthy coping strategy. The volunteer should tell the team the plan quietly. For a second time, the team should act out the entire skit with the volunteer, this time with the stressed teen coping in a healthy way. 3. Assign teams (either by choice or another method). 4. Give a handout and assign a situation to each team. 5. Allow teams to prepare and practice. 6. Have each team present, following step #2. UNHEALTHY coping strategies may harm you or others and in the long term they don t reduce the stress. Getting into a fight is an example of an unhealthy coping strategy. HEALTHY coping strategies focus on the positive and what you can change or control in your life. Writing in a journal or playing a sport are examples of healthy coping strategies. Closure: Tell the teens they have 1 minute to call out as many healthy coping strategies as they can. Count them up and suggest they try one they ve never tried before the next time they are feeling stressed. Page 12 Confronting Teen Stress

13 Self-Expression Self-expression is an important part of a teen s life and provides a positive way of coping with life s stresses. Regardless of the subject you teach or the type of program you run, you may find it useful to include self-expression in your activities. Teens bring their stress into the classroom or program, and it often is difficult to work with them when they are feeling stressed. By incorporating a daily or weekly 5-minute Stress Chat, you can encourage teens to explore their stress and share coping strategies. You also can encourage teens to write a poem or song lyrics or to draw a picture about their feelings. Suggest a few topics (schoolwork, home life, etc.) or let them come up with their own topic. Invite teens to share their self-expression. Check out this poem by a Baltimore teen. I Feel Stress As stress builds up I begin to cry. I hide. Not my body, but my mind. I can no longer think of anything I used to think about. I can no longer feel what I used to feel Things seem unreal. Life. Stress. I feel stress. Excerpt from I Feel Stress, by Kellie Briscoe, October 2, 2002 Additional Resources for Working in Large Groups Poetry Slam, Inc. provides info on planning a slam. Go to: Acting It Out: 74 Short Plays for Starting Discussions With Teenagers, by Joan Sturkie and Marsh Cassady, Ph.D. $ Look for it on-line or in your bookstore. The Mentura Learning Guide provides activities for use with young people of all ages. The guide is 6 pages. You also can obtain a DVD, The Joy of Stress. Find the guide at: Meeting the Challenge in Baltimore City Page 13

14 Handout # 1 and Handout #1 Stress ChecklistHandou/tHa# 1 This stress checklist may help you assess a teen s level of current stress. This is only a guide to explore teen stress and should not be used as a diagnostic tool. You may use this checklist to ask a teen about what he or she is experiencing or you may review it together. Refer to page 8 for more information on how to act on what you learn from this checklist. 1. Have you recently encountered these or other life experiences that may cause you stress? Loss of a loved one Extra work or being overscheduled Someone moving into the home An argument with a friend or family member Frequent teasing from family members or classmates Someone says something about you that you already don t feel good about 2.Have you felt any of the following symptoms once or twice in the past two weeks? Tired Overwhelmed Difficulty concentrating Headaches Low motivation Difficulty remembering things Not getting much done Difficulty making decisions 3.Have you felt any of the above symptoms (from #2) more frequently, and/or any of the following symptoms in the past two weeks? Sadness or worry Increased heart rate Changes in how you usually eat Feeling hopeless or helpless Anger that you cannot control Difficulty breathing Nightmares or disturbing thoughts Difficulty sleeping Sources: Adapted from National Mental Health Association (www.nmha.org), Ball State University Counseling Center (www.bsu.edu/students/cpsc/) Page 14 Confronting Teen Stress

15 Mind-Body Connection Handout # 2 Handout #2 Think of a specific time when you felt stressed out in the past two weeks. How did that stress make you feel? On the body below, draw where and how the stress affected you. You may draw any pictures or symbols and may use any colors you choose. Meeting the Challenge in Baltimore City Page 15

16 Instructions Coping With It Handout # 3 Handout #3 1. In your team, plan a short skit with a role for each person using the assigned situation. 2. Pick an unhealthy way that the teen in your skit will cope with the stressful situation. 3. After practicing, present the skit to the entire group. a. After you present, the large group will comment on the unhealthy coping strategy. b. Choose one volunteer from the large group to take the place of the stressed teen and act out a healthy coping strategy. The volunteer should tell you the plan. c. For a second time, your team should act out the entire skit with the volunteer, this time with the stressed teen coping in a healthy way. Situations (You will be assigned one of these situations.) A. Bobby is 17 years old. He is having some problems with his girlfriend. He feels that she is always checking up on him and says that she doesn t trust him. He is feeling a lot of stress from this situation. He can t seem to concentrate or getting anything done at school. B. Sherneice is 14 years old. She can t stand walking home from school every day. She gets harassed and called names by men in her neighborhood. She is so anxious and stressed by the problem that she hasn t been able to get enough sleep. C. Alan is 12 years old. Every day, he is getting into arguments with his math teacher. He feels that his teacher is treating him unfairly. Since he is so stressed out over this problem with his teacher, he gets angry with everyone in his life including his mom and his little brother. D. Angela is 13 years old. She feels like her mom puts too many responsibilities on her at home, such as taking care of her little sister every day. She can t stop thinking about all that she has to get done at home and at school. E. Gretchen is 15 years old. She just heard that someone at school has been talking about her and telling stories that are not true. This problem is really getting to her. Page 16 Confronting Teen Stress

17 Helpful Resources For More Information Focus Adolescent Services provides information on helping teenagers with stress. Go to: The American Academy of Child and Adolescent Psychiatry provides information on how others can help teens with their stress. Go to: Adult Stress Your Medical Source provides information to help adults deal with their stress. Go to: Understanding and Minimizing Staff Burnout is a booklet that addresses sources and symptoms of burnout. Go to: Baltimore Services The Baltimore City Services has a list of service for youth and families. Go to: Refer a teen (12-17 years old) to the Baltimore Rising youth violence reduction initiative. Go to: Working With Teens Free Spirit publishes many self-help books for teens. Go to: The Shifting the Lens Teen Video Production Team has produced Focus on Teens, a video for parents and other adults. Download the 13-minute video at: Wide Angle Community Media s youth producers have created an audio CD on teen stress. Contact Sue at: for a copy. Baltimore s Site for Teens by Teens (also great for adults!) Go to: For additional teen websites, refer to the teen pamphlet on pages 17 and 18. Meeting the Challenge in Baltimore City Page 19

18 Collaborators The following individuals partnered in the development of this guide. Special thanks to the Centers for Disease Control and Prevention, the Shapiro Family Foundation, and the Zanvyl and Isabelle Krieger Fund for support, and to members of the Community Advisory Board and staff of the Center for Adolescent Health for their review of this guide. Carol Barnes, Parent Amy Bloom Connolly, MS, Educator & Consultant S.H.I.N.E. Community Development Program & Mindfulness Programs Gretchen Bracey, Student Walbrook High School Debbie Ehler, High School Teacher Frederick Douglass High School Gin Ferrara, Director Susan Hayman, Outreach Coordinator Kira Lanier, Intern Wide Angle Community Media Michael Lindsey, PhD, MSW, MPH, Assistant Professor University of Maryland School of Social Work Charmayne D. Little, MBA, Executive Director SouthEast Youth Academy Annelle B. Primm, MD, MPH, Director Department of Minority and National Affairs American Psychiatric Association Rebecca Yenawine, Director Kids on the Hill The Center for Adolescent Health is sponsored by the Prevention Research Centers Program, National Center for Chronic Disease Prevention and Health Promotion of the Centers for Disease Control and Prevention (CDC) To obtain copies of this guide, go to: or call

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